Irritable Bowel Syndrome

Henry is in his late twenties.  He is a computer expert, working for a large company, travelling to various company offices to work on computer systems.  Many of these offices are in London, so Henry uses the public transport system in London a great deal.  Henry had suffered for some five years from increasingly frequent attacks of diarrhoea, and extensive medical tests had revealed no organic cause.  The problem had been diagnosed as Irritable Bowel Syndrome, or IBS. 

Henry found it particularly difficult travelling on the London Underground when subject to these attacks, because this could easily involve travelling for half an hour or more, enclosed in a carriage and with no access to toilets.  Henry disliked crowded places at the best of times, and the added stress of spending lengthy periods in a crowded underground carriage could precipitate an IBS attack.  Of course, the worry that this might happen made the problem worse.

Irritable Bowel Syndrome is known to be exacerbated by stress, and when Henry sought therapy, the therapist began by using established stress-management techniques.  However, these proved to be of limited effectiveness.  When the therapist suggested Provocative Therapy, Henry was initially doubtful, but agreed to try this new approach.

During the time-limited session, the therapist began by inviting Henry to state the problem again– then began with mock horror to agree with him that the problem really was a terrible one– that, actually, things were far worse than Henry had realised.  What if the diarrhoea led to a full scale 'accident' while in the underground train carriage!  With increasingly graphic descriptive language, he began describing the drama– including the smell, and the reaction of the other passengers on the train, backing away! 

Then, as though as an afterthought, the therapist suggested that, since Henry didn't like crowded carriages, the people backing away was a distinct advantage– there would be no crowds around Henry, that's for sure– so maybe the IBS had been trying to help all the time!  The client burst out laughing.  The session ended after more of the same bizarre and zany suggestions, and the therapist gave Henry a task– when on the tube, he should look out for others who were looking anxious, as though they were waiting for something to happen– but don't stand too close!

The above suggestion was just one of the approaches used with this client, but in the therapist's judgment was a major turning point for Henry.  Within three months, Henry had no IBS symptoms at all: no dirrhoea, no pain, and no difficulty travelling on the underground.

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